The fourth "Healing Our Spirit Worldwide" gathering was held in Albuquerque NM, in September 2002. This conference, originated in 1992, has evolved in one of the major forums for the discussion of Indigenous health issues at a global level. During the Gathering, delegations from the US, Australia, Canada, New Zealand, and Latin America, voiced their opinions on Indigenous public health issues. A strong emphasis was devoted to culturally appropriate interventions in regards to issues related to substance abuse and other public health issues. One of the most interesting and absorbing topics was represented by debate on Historical Trauma, the subject of the article.

The discussion of this subject was organized in a panel format including some of the main Native American scholars working on the theme: Maria Brave Heart, Bonnie Duran, Eduardo Duran, Karina Walters, Tassy Parker, Lori Jervis, and Marcello Maviglia, the author of this article, honored to be on the panel. In the next few pages I will try to give an overview of the concept of historical trauma by combining the content of the panel presentation with the main theoretical points available in the current literature. My goal is to give a modest contribution to the ongoing efforts to define this concept. Towards the same goal, I hope to elicit constructive criticisms from readers and scholars interested in the topic.

Introduction:

Although a definitive conceptualization of historical trauma has to be reached yet, a working definition from the writing of Native American scholars views historical trauma as the psychological, physical, social and cultural aftermath of the process of colonialism and post colonialism to which Indigenous people have been subjected. In order to clarify the essential structure of historical trauma, it is necessary to describe two related, but at the same time differing entities: PTSD and Intergenerational Trauma. The intent will be traumatic experiences around the world. Exploration of the historical and psychological dynamic of trauma along with culturally sensitive approaches will also be attempted.

The underpinning guiding principle in the article is that non-culturally specific interventions are not only ineffective, but also potentially instrumental to the perpetuating and reenacting of the experience of the trauma. Also, the therapeutic approach will be viewed as a tool for empowerment, conceptualized as the development of a self guided indigenous process for the reconstitution of lost cultural and societal capitals.

The need for the development of a historical consciousness will also be approached as a necessary step towards the attainment of this goal. Finally, the implementation of culturally sensitive research modalities based on qualitative models (methods), will be raised as appropriate means of inquiry.

Towards Definition of Historical Trauma:

The concept of historical trauma has developed as a natural consequence of tragic historical events affecting the psyche of Indigenous Peoples, and as a reaction to the narrow definition of trauma as expressed through the clinical entity of PTSD (1).

PTSD, in fact, is mainly focused on the clinical symptoms following a circumscribed traumatic experience. These symptoms can be grouped in two main categories: the "intrusive" and the "numbing" manifestations of trauma. The "intrusive" category includes: hyperactivity, explosiveness, nightmares related to the traumatic event and flashbacks. In the "numbing" realm we find: social isolation, inability to explore pleasure or satisfaction, and avoidance of obligations (2). These two, summarily described, convey a mechanical-biological picture of trauma, evoking alternating phases of neuronal hyperactivity (intrusion) and hypo activity (numbing).

However, experiences from the Holocaust, dictatorial regimes, episodes of ethnic cleansing, political persecution, etc., show that the consequences of trauma could, and often are, transferred from one generation to the next. The clinical manifestations are analogous to those witnessed in PTSD but extended in an intergenerational fashion, definable therefore as Intergenerational Trauma (3). Although this entity definitely broadens the scope of the traumatic experience, it does not engulf an analysis of the historical context in which trauma originates and therefore is not sufficient to fully explain the psychic damage deriving from the colonial and postcolonial experience in Indigenous populations (4).

The understanding of Historical Trauma presupposes, in fact, the evaluation of the experience of a psychological "fragmentation" in the context of the colonial and postcolonial frame. The identification of this process would therefore include understanding governmental Indigenous policies as subtler and insidious causes of trauma, because of their apparent legitimate political and legislative tone. The psychosocial consequences stemming from these vicissitudes can be expected as partially having the DSM noseology, but essentially an existential frame, not as amenable to official classification.

At this point it will be useful to engage in a careful speculation of what could be a conceptualization of Historical Trauma. Starting from the stated premises, we could formulate the following working outline:

1. A historical existential dimension, whose most salient characteristic is a sense of "not belonging", estrangement from the relationship with Indigenous cycle of life, definable in traditional sociological terms as Anomie (4).
2. Another part, closely related to the PTSD nomenclature, occurring from more discrete traumatic situation, enacted in the background of specifically deleterious historical processes. Indeed, it is worthwhile to observe that a lot of the circumscribed traumatic events in Native Country develop in a scenario of poverty, unemployment, and social injustice: They could be viewed as an appendix of historically traumatic events.

Clinical and Emotional Manifestations:

The existential-historical-emotional manifestations could not have the clearly defined boundaries of a clinical syndrome like PTSD because the "existential" is essentially personal, subjective, social, and political. The pathology, however, is no less real or painful: If anything, its manifestations raise the subject of the inadequacy of Western methodological screening and testing procedures of phenomena not happening within the realm of the dominant society (5). From the literature available, and the direct feedback of Native American scholars, and professionals, the existential-historical aspects of historical trauma could be summarized as follows (6):

1. Communal feelings of disruption of the family and societal network,

 

2. Development of an existential form of depression, based on a sense of communal disruption and anomie,

 

3. Ambivalence and anxiety about feeling part of the historical ancestral pain, and the tempting option to adopt the easily accessible Western attitudes, values, and sociocultural models,

 

4. Development of chronic existential grief, nested in the dominant context of denial and silence. This angst is typically manifested through the complete rubric of destructive and self-annihilating behaviors (including some pattern of drinking and substance abuse),

 

5. The daily re-experience of colonial aspects of trauma stemming from stereotyping, and racism, which are the base for the above described emotional states, and
6. Lack of resolution of the existential dimension triggering an individual, intergenerational, and communal extension of the existential pain.

From what has been stated, it would appear evident that decontextualized modalities focusing on circumscribed biological and psychotherapeutic attempts are bound to yield marginal results, if any.

Indeed, several Native American scholars, such as Spero M. Manson, Bonnie Duran, Eduardo Duran, and Maria Yellow Horse Braveheart, to name but a few, have responded to these shortcomings by voicing the importance of cultural appropriateness in the treatment of Indigenous health care problems (7-12). Their views, echoed in the US Surgeon General Report (13), constitute a pressing testimony to the importance of developing appropriate approaches for psychiatric disorders affecting native populations, including trauma. Moreover, there is a unanimous agreement among Native researchers that the core of Native American mental health issues can only be understood through an understanding of historical traumatic events (8-12).

However, as instinctively and rationally valid these views may appear, substantial criticism has already been expressed, mainly by professional and scholars representing the Western psychiatric ideology. Their views about historical trauma, mainly expressed in informal settings in order to avoid political clashes, can be summed in one basic statement: The concept of historical trauma doesn’t have a demonstrated validity.

Although this criticism could be superficially viewed as correct, it dismisses the fact that the construct is evolving, and it has a huge resonance with Native People. It also ignores that the PTSD entity is in itself questionable from this viewpoint. Moreover, the possibility of cultural and ideological bias, the lack of historical perspective, and the presence of political and financial interests need to be taken into account in the analysis. It would, therefore, be worthwhile to spend sometime in clarifying the ideological and political process through which Western scientific knowledge is constructed, and how it is related to the establishment of the diagnostic category of PTSD.

The establishment of scientific entities can be summarily conceptualized as including 3 major steps (14): Externalization, Objectification, and Reification. The phase of Externalization is focused on the verbalizing and voicing of the newly developed concept. It is a tentative step, initiated by the promoting party, with the intent of capturing the receptivity, mostly of the scientific establishment, to the new idea. The process of Objectification consists in the translation of the new idea into viable, acceptable, "scientific" frame. This process, in reality is just as much political as it is about science; it often includes a very intense networking with targeted scientific entities to gain their active support. The third, the stage of Internalization, can be viewed as the final step with the goal of integrating the reified knowledge into the daily social vocabulary. This is probably, the most political and propagandistic stage; it heavily capitalizes on the financial and social resources available; the richer, the better.

The establishment of the PTSD entity went through similar steps, with a fundamental difference: the victims themselves, (mainly Vietnam Vets), were the proponents of it. This scenario does not happen too often in medicine, and especially few decades ago, represented a revolutionary change: The shifting of the axis of production of medical and scientific knowledge from the establishment to the consumers. Besides that, the validation of this entity followed, more or less, the described stages.

At the end of the Vietnam conflict, a substantial group of veterans were left on their own to deal with the psychological, social, and financial scars derived from their involvement in the conflict. However, the attempts at communicating their psychological discomfort seemed to fall, repeatedly, on deaf ears. Positive outcomes were reached by the adoption of a strategy based on the following points, (15):

1. Networking with sympathetic "insiders" and professionals receptive to their plight.
2. Establishment of ideological support from groups knowledgeable about the Jewish Holocaust.
3. Gaining validation from survivors of industrial natural catastrophes.

These strategies were proved essential for the inclusion of the entity into the DSM. It is worthwhile to stress that when the diagnosis was finally accepted, the doubts about its validity were still being raised and voiced, proving that the process was not just about science.

The most valuable lesson from this segment of our psychiatric chronicle is, in my view, the possibility of being emulated and transferred to a strategy of divulgation and acceptance of Historical Trauma. Fanon, one of the most emblematic figures in the conceptualization of psychological problems stemming from colonialism, eloquently advocates for strategies leading to a reframing knowledge from the perspective of the oppressed. He perceptively understood that the disastrous social and psychological situation of the so called third world would not improve until it continued to be defined according to the standards of the European thinking (16).

Duran and Duran (4) cleverly reframed Fanon’s views of the consequences of the colonial process as "acute or chronic reaction to colonialism", setting the base for reframing of the Indigenous experience with trauma.

Psychodynamics and Treatment Issues:

Unfortunately, Native concepts of illness are often ignored. Although it is virtually impossible to engage in a satisfactory review of even the most fundamental concepts of Indigenous healing, it is imperative to state that there are some peculiar, specific ways in which Traditional people tend to define illness and the phenomenology of trauma. Allowing for expectable differences from one community to another, we can find general themes in the conceptualization of psychobiological indigenous pathology. They could be summed up as stemming from two main mechanisms, (4):

1. Eradication of the quintessential "vital lymph", by transcendental, negative, and abducting forces.
2. Insidious and erosive spreading of a corruptive, destructive force in the body.

This double mythological paradigm of extirpation and invasion is pivotal to the understanding of Internalized Oppression. This phenomenon, in fact, could be defined as the "colonization" of the mind as it is based on the embedding of the values of the colonizer into the psyche of the Indigenous mind, and manifesting in the emotional and cognitive states of historical trauma. This process assumes a very subtle and insidious course, as the traumatized and oppressed individual may actually rely on his Indigenous cultural paradigms to explain colonially induced pathological behavior and, therefore, triggering a self-blaming reaction.

An example would be the extremely self derogatory position of a Native individual who, with his drinking, has caused disruption to himself, his family, and, as a consequence, been shunned by the community as an iconoclast. Not discontinuing individual responsibility, this not unusual occurrence totally overlooks the presence and the effect of contextual issues in the genesis of asocial behaviors. Undeniably, the development of a psychodynamic formulation and therapeutic approach should not be isolated from an understanding of the historical phases through which Native Cultures have interacted and clashed with the Western European civilization. There is indeed agreement that the overall schema of this process can generate a reasonably accurate understanding of current psychological problems. The process can be summed up in four major stages (17):

1. The Colonizing Period, characterized by the establishment of definite policies leading to the appropriation of Native American lands and resources.
2. The Relocation Period represented by the forceful relocation of Indigenous people in often unfamiliar territories.
3. The Boarding School Period, finalized to the annihilation of the cultural characteristics of the Native population by enrolling Native youth into Boarding Schools, under the pretenses of fostering the development of competent and integrated American citizens.
4. The last step, Termination Period, consistent in the additional and substantial removal of families from Reservation land into urban area, with the unrealized promise of a better life.

Although these phases present overlapping aspects, they reflect two distinct and concrete themes: One characterized by the dispossession of the land base, during the initial colonial phase; and another typified by the more subtle policy-making period, focusing on the extirpation of cultural roots, destruction of the language, customs.

These two motifs are certainty basic for the understanding of the development of the Indigenous sense of identity. It is reasonable to speculate that the colonized individual stalled in the passive position of total acceptance of dominant values, will develop an unhealthy sense of self. This is mainly due to the stunting of the critical capacity to appreciate and analyze one’s roots and culture in the context of the Western European paradigms.

Another deleterious aspect is represented by the impact that the historical vicissitudes have had on the traditional role of women. The Native American sensitivity has traditionally viewed the feminine soul as synonym of the earth, and the source of life. One of her most noble functions has been to act as a comforting entity to the male soul. Although more than one allegoric image could be found to describe her task, the traditional Native Ceremony of the Sun Dance can be sued as emblematic (4). During the dance, the female stands beside the male to support him in the synchronic and cathartic movement towards a personal and communal renovation. However, this nurturing role, symbolized by the symbiotic dancing steps, has changed through the ages by the consequences of trauma on the male psychology. The woman is forced in the position of assisting a male dancing out of step, showing a disconnection with the traditional community and at times engaging in negative and destructive behavior: the steps originally leading to the rebirth, now lead to Thanatos. In summary, the matriarchal-matrilineal tradition and wisdom are translated into dysfunctional-masochistic support, so distant from the original archetypal function.

This picture obviously implies the presence of children and adolescents, whose possibilities for identification with their own roots and culture are highly disrupted. The example is intended to convey the point that therapeutic approaches should be informed by the general themes found in the mythological and cultural beliefs.

It should also be pointed out that the concept of Native therapy is centered on the authoritative figure of the Healer and, therefore, the focus on "client centered approaches", tested on Indigenous patients, may not be appropriate. Additionally, there are no Western based interventions proved to be effective with Native People; this lack of efficacy is shown by the high dropout rate from therapy (18). It would also be reasonable to view the empirically tested approaches, as an extension of the dominant thinking, and therefore representing an extension of the traumatic experience. Duran and Duran, aware of these dynamics, capture as the distinctive objective of therapy for Native populations, the exorcizing of the "Western Aggressor" from the individual and the communal psyche (4). They propound the view that the aberrations of the Indigenous soul are characterized by the breakdown in the connections within the harmony of the traditional cycle of life, and not by the linear cause-effect relationship between the pathogen and the host as viewed by Western medical science. It follows that the reductive medical model is not sufficient in the appraisal of another problem affecting a percentage of Native Americans-dysfunctional drinking. Only a historical —contextual approach to this problem would shed some light on drinking-related problems in Indian communities.

Alcohol was introduced in Indigenous America during the early phases of colonization, within a context of economic and financial exploitation, responsible for its unhealthy use (19). Indeed, hard liquor was used as a tool for bartering with the Natives, who were therefore faced with the hard task of managing the proper use of a substance totally unfamiliar to them. A "mature" use of alcohol would have required the time for its gradual assimilation in the cultural and social fabric. Moreover, the heavy and dysfunctional use of alcohol not uncommonly observed in the white culture, functioned as a modeling effect (19).

Some enlightened Native American leaders, fully conscious of the colonial implications of heavy drinking, took steps to offset the problem. The most charismatic leader of this "awareness movement" was the Seneca prophet, Handsome Lake. He viewed abstinence as the tool for political, cultural, societal survival and renewal; and, in the cultural revival he identified the spring for a renewed interest in the conservation of the land, the necessary source of life. He is said to have received his insights from visions and dreams, from the "world of spirits". It is indeed through his understanding of alcohol as "controlling-colonizing" spirit that he reached his stance against this substance, (4). In his mystical language, "booze" speaks the political idiom of the colonizer in a fluid form, as if each drop is representing another malignant clause to the long list of the deceiving laws, policies, and dispositions already tragically experienced.

As part of the therapeutic issues, it is also important to mention the concept of "cultural historical transference", defined as the reaction of the Indigenous patient to the cultural and historical values represented by the mental health professional. This entity, usually ignored in the practice of psychotherapy, or mistaken for psychoanalytic transference, usually manifest as rage, paranoia, reluctance to "open up" is often wrongly judged as a sign of a personality disturbance.

In order to avoid this pitfall, the therapeutic relationship needs to follow two essential paths: One vertical, facing history; the other, horizontal, relating to the current cultural, social and psychological manifestation of the Ancestral Pain, or trauma.

The role of the Western trained expert in this context will therefore entail a serious attempt to understand the history and the societal structure of the Native community to which the individual belongs. However, in order to avoid a static approach to Native cultures, it is also necessary to be aware of the current social and economic changes affecting Native societies.

Although it is not in the scope of this article to discuss this topic in detail, one aspect deserving mention is the massive and swift introduction of legalized gambling in Native societies. This topic is indeed the subject of intense debate within Native communities, because of the potential and radial societal and cultural changes, which could engender. These carry the possibility for an exacerbation and radicalization of the traumatic themes already present in the collective psyche.

Use of Focus Groups:

A methodology of inquiry, known as qualitative approach, based on the concept of obtaining knowledge directly from the members of the community, is steadily gaining popularity with Indigenous researchers (20). It is primarily based on the use of focus groups. In the context of this modality, groups of individuals (patients, professional, community members, etc) are allowed to brainstorm with the goal of producing solutions, consistent with the local cultures and perspectives. It is indeed an approach often guided by individual who traditionally would be considered the subjects of the study; it, therefore, represents a shift from a passive to an empowered position, encompassing both the roles of researcher and subject. This model could be successfully sued for an emic and systematic definition of historical trauma. It represents an empowering process analogous for certain aspects to one in which the veterans, propounding the idea of PTSD, engaged. It will also allow for a first hand report of the emotional states and possible clinical features related to specific communal traumatizing events. Additionally, it could help to characterize the psychodynamic process as distinct from symptomatic manifestations; the lack of distinction between these two entities is, in fact, responsible for most criticisms raised about the validity of the proposed concept.

Conclusion:

This modest contribution is an attempt to plant a small seed in the evolving field of Historical Trauma. The immense latitude of the subject forbids an extensive elaboration of all the aspect mentioned, and is responsible for the omission of many others. But, hopefully the main point has been clearly conveyed: Historical Trauma is as real as the emotional and psychological pain of numerous Indigenous people; it is just awaiting a systematic definition, which hopefully will represent the concept in all its contextual and existential essence.

References:

1) Brave Heart, M. & DeBruyn, L. (1998). The America Indian Holocaust: Healing historical unresolved grief. American Indian and Alaskan Native Mental Health Research, 8, 60-82.

2) American Psychiatric Association, (1994). Diagnostic and statistical manual of mental disorders (4^th ed.), Washington DC.

3) Berger, L (1988). The long-term psychological consequences of the Holocaust on survivors and their offspring. In R.L. Braham, (Ed), the psychological perspective of the Holocaust and of its aftermath (pp175-221). New York: Columbia University Press.

4) Duran, E, & Duran B. (1995). Native American post-colonial psychology. Albany, NY: State University of New York.

5) Pavkov, T. W., Lewis D. A., and Lyons, J. S. 1989. Psychiatric diagnosis and racial bias: An empirical investigation. Professional Psychology: Research & Practice 20:364-368.

6) Duran, B., Duran, E., and Yellow Horse, M. 1998. Native Americans and the Trauma of History. In R. Thornton (Ed.) Studying Native America: Problems and Prospects in Native American Studies. Madison, WI: University of Wisconsin Press.

7) Manson, S. M., Shore, J. H., and Bloom J. D. 1985. The Depressive experience in American Indian communities: A challenge for psychiatric theory and diagnosis. Pages 331-338 in Culture and Depression: Studies in the Anthropology and Cross-Cultural Psychiatry of Affect and Disorder, Arthur Kleinman and Byron Good (Eds.). Berkeley, CA: University of California Press.

8) Manson, S. M. 1995. Culture and major depression: Current challenges in the diagnosis of mood disorders. Cultural Psychiatry, 18 (3): 487-501.

9) Duran, B., Duran, E., and Yellow Horse Brave Heart, M. 1998. Native America and the trauma of history. Pages 60-76 in Studying Native America: Problems and Prospects in Native American Studies, R. Thronton (Ed). Madison, WI: University of Wisconsin Press.

10) Yellow Horse Brave Heart, M., DeBruyn, L.M. 1998. The American Indian holocaust: Healing historical unresolved grief. American Indian and Alaska Native Mental Health Research 8(2):56-78.

11) Yellow Horse Brave Heart, M. 1999. Gender differences in the historical trauma response among the Lakota. Journal of Health and Social Policy, 10 (4):1-21.

12) Manson, S. M. 1996. The wounded spirit: A cultural formulation of post-traumatic stress disorder. Culture, Medicine, and Psychiatry. 20:489-498.

13) US Department of Health and Human Services, 2001. Executive Summary. Mental Health: Culture, Race, and Ethnicity, a Supplement to Mental Health: A Report of the Surgeon General [On-line], August 28, 2001. Available: http:// phs.os.dhhs.gov/library/mentalhelath/cre/execsummary.

14) Berger, P., and Luckmann, T. 1966. The Social Construction of Reality. New York: Doubleday and Company, Inc.

15) Kutchins, H., and A. K. Stuart. 1997. Making Us Crazy, DSM: The Psychiatric Bible and the Creation of Mental Disorders. New York: The Free Press.

16) Bulhan, H. A. 1985. Frantz Fanon and the Psychology of Oppression. New York: Plenum Press.

17) Kawamoto, W. T. 2001. Community Mental Health and Family Issues in Socio-cultural Context. American Behavioral Scientist 44 (9): 1482-1491.

18) Sue, D. W. 1981. Counseling the Culturally Different. New York: John Wiley & Sons.

19) Unrah, W. E. 1996. White Man’s Wicked Water: The Alcohol Trade and Prohibition in Indian Country, 1802-1892. Lawrence, KS: University Press of Kansas.

20) Roter, D. and R. Frankel. 1992. Quantitative and Qualitative Approaches to the Evaluation of the Medical Dialogue. Social Science and Medicine 34(10):1097-1103.